CHALLENGES AND INTERVENTIONS FOR CHILDREN WITH ADHD IN THE EARLY YEARS

Transcription

1 CHALLENGES AND INTERVENTIONS FOR CHILDREN WITH ADHD IN THE EARLY YEARS Dr Madeline Marczak Principal Clinical Psychologist CYP-IAPT PT/0-5s Lead Children and Parents Service

2 OVERVIEW Prevalence ADHD and under 5 s what does this look like? Differential diagnosis when is ADHD not ADHD! Best practice guidance for ADHD in pre-school children Incredible Years as a recommended intervention The role of coaching in supporting children s self-esteem, social-skills and emotional regulation.

3 PREVALENCE In comparison to school-age children population prevalence of ADHD in pre-schoolers is less well studied however estimates are in the range of 1.8/1.9% (Schlack et al, 2007; Wichstrom et al, 2012). Significant World-wide variation. Danielson (2017) : US Prevelance In 2011 to 2012, approximately 237,000 children aged 2 to 5 years in the United States had an ADHD diagnosis, based on parent report. The number of young children with ADHD increased by more than 50% from the survey. Over 100,000 of them had received the ADHD diagnosis before the age of 4 years. More than half of young children with current ADHD had at least one co-occurring condition. The most common co-occurring conditions were developmental delays and behavioral disorders like oppositional defiant disorder or conduct disorder. Russell et al (2013): Children in US more likely to receive a diagnosis of ADHD than in the UK (6.3% population vs 1.5%).

4 ADHD IN PRE-SCHOOL CHILDREN

5 ADHD in pre-school children what does this look like? Executive Functioning Difficulties: Thorell, & Wahlstedt (2006 Inhibition Impairments (Schoemaker, 2011) Low self-esteem Peer relationship difficulties (Menting, Van Lier, & Koot, 2011) Attainment difficulties DuPaul (2001): Pre-school children with ADHD are at significant risk for behavioural, social, familial and academic difficulties relative to their typical counterparts.

6 DIFFENTIAL DIAGNOSIS WHEN IS ADHD NOT ADHD? Typical Developmental Functioning ADHD Developmental Trauma and Attachment Difficulties

7 NICE GUIDANCE FOR ADHD (2008) Pre-school children. Drug treatment is not recommended. Group-based parent-training/education programmes, developed for the treatment and management of children with conduct disorders, should be fully accessible to parents or carers of children with ADHD whether or not the child also has a formal diagnosis of conduct disorder. Same programme requirements for conduct disorder

8 Danielson et al (2017)

9 US Centre for Disease Control and Prevention. nfographics/treatments-preschool.html

10 SPECIFIC COMPONENTS OF EFFECTIVE PROGRAMMES Structure NICE clinical guideline 158 recommendation states that group parent training programmes should: Involve both parents if this is possible. Typically have between 10 and 12 parents in a group Be based on a social learning model, using modelling, rehearsal and feedback to improve parenting skills Typically consist of 10 to 16 meetings of 90 to 120 minutes' duration Adhere to the developer's manual and employ all of the necessary materials to ensure consistent implementation of the programme. The manual should have been positively evaluated in a randomised controlled trial. Content New parenting skills must be modelled and rehearsed Home-based practice or homework Parenting programmes should be collaborative & emphasise principles rather than prescribe techniques Non-violent sanctions for negative behaviour Relationship building, praise, fun & play, rewards, reinforcement Must address difficulties in adult relationships or other family problems

11 WHY INCREDIBLE YEARS?

12 TAILORING IY FOR ADHD (WEBSTER-STRATTON & REID, 2014) Extra vignettes from the Child-Directed Play and Emotional Regulation programs. More content covering social and emotional coaching and activities regarding school readiness. Consider temperament and positive opposites to focus away from negative Increase frequency and intensity of praise and tangible rewards getting the child s attention first, use of non-verbal/social praise and rewards Clear visual routines and limit setting consequences immediate and as closely related to behaviour as possible. ADHD session plans available at incredibleyears.com/.../checklists-agenda-parent-program-adhd-protocol

13 Webster Stratton, 2008 Non-violant discipline through consequences and time-out. Emotional regulation as a key outcome. Importance of structure and routine. Clear Limits and Commands Increase praise and tangible rewards. Importance of positive opposites Importance of improved parent-infant relationship building. Significance of coaching to support social, emotional and academic functioning.

14 PARENTS EXPERIENCES OF THE IY PROGRAMME

15 THE ROLE OF COACHING IN ADHD. Descriptive Commenting Academic coaching Persistence coaching Social coaching Emotion coaching

16 PERSISTENCE COACHING HOW IT WORKS Recognising the child s internal state of mind as well as the physical behaviours that go along with that state is especially important for children who are inattentive, easily frustrated, impulsive or hyperactive. Labelling the times a child is focussed and persisting patiently with a difficult task enables the child to recognise that internal state, what it feels like, and put a word to it the child learns that it is normal to find it hard to learn a new skill, but that with patience and persistence he or she will be able to eventually accomplish the task. Webster-Stratton and Reid, 2009, p.252

17 Impact of coaching on pre-school children with ADHD Better emotional regulation and improvements in executive functioning Improves Self-esteem Improved Social Skills relationship difficulties Improved school readiness and attainment

18 KEY REFERENCES Danielson ML, Visser SN, Gleason MM, Peacock G, Claussen AH, Blumberg SJ. (2017) A National Profile of Attention- Deficit Hyperactivity Disorder Diagnosis and Treatment Among US Children Aged 2 to 5 Years. Journal of Developmental and Behavioral Pediatrics, 38(7), DuPaul, G. J., McGoey, K. E., Eckert, T. L., & Van Brakle, J. (2001). Preschool children with attention-deficit/hyperactivity disorder: Impairments in behavioral, social, and school functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 40, NICE (2016) Attention deficit hyperactivity disorder: diagnosis and management. Uploaded from Russell, G., Rodgers, L.R., Obioha, C. Ukoumunne, T.F. (2013) Prevalence of Parent-Reported ASD and ADHD in the UK: Findings from the Millennium Cohort Study. Journal of Autism and Developmental Disorders, 2013; DOI: /s Schlack R, Hölling H, Kurth BM, et al. (2007) The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50: Webster Stratton, C. & Reid, J. (2014) Tailoring the Incredible Years Parent, Teacher, and Child Interventions for Young Children with ADHD. Uploaded from Wichstrøm L, Berg-Nielsen TS, Angold A, et al. (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry; 53: